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Chakera A, Harrison S, Mitchell J, Oliver C, Ralph M, Shelton C. The Nitrous Oxide Project: assessment of advocacy and national directives to deliver mitigation of anaesthetic nitrous oxide. Anaesthesia 2024; 79:270-277. [PMID: 38205565 DOI: 10.1111/anae.16211] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/12/2024]
Abstract
The environmental emissions attributed to anaesthetic nitrous oxide across the NHS are comparable to the carbon dioxide released by 135,000 flights from Frankfurt to New York. Much of these emissions are attributable to cumbersome and inadequately managed piped systems, resulting in excessive loss and waste. Since 2020, multiple hospital sites have been engaging with the Nitrous Oxide Project, a quality improvement method supporting a 'lean systems' approach to the provision of nitrous oxide. This review considers the frameworks supporting medical gas management in UK healthcare systems, and the impact of professional advocacy and medical gas stewardship to drive anaesthetic nitrous oxide mitigation in the NHS. Nitrous oxide mitigation efforts by grassroots and professional advocacy networks are enhanced through national centralised emission monitoring, distribution of data, technical information and provision of quality analysis. Given the climate harms of nitrous oxide, concerted efforts should be made to rationalise its use, and resources should be committed to supporting this at local, regional and national levels.
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Affiliation(s)
- A Chakera
- Health Infrastructure and Sustainability, Scottish Government, Edinburgh, UK
- The Nitrous Oxide Project, Edinburgh, UK
| | - S Harrison
- Northwest School of Anaesthesia, Manchester, UK
| | - J Mitchell
- Department of Anaesthesia, University Hospital Ayr, Ayr, UK
| | - C Oliver
- Department of Anaesthesia, University Hospital of Wales, Cardiff, UK
| | - M Ralph
- Engineering and Assurance, NHS Scotland Assure, Glasgow, UK
| | - C Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester, UK
- Lancaster Medical School, Lancaster University, Lancaster, UK
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Kelly FE, Bailey CR, Aldridge P, Brennan PA, Hardy RP, Henrys P, Hussain A, Jenkins M, Lang A, McGuire N, McNarry A, Osborn M, Pittilla L, Ralph M, Sarkar S, Taft D. Fire safety and emergency evacuation guidelines for intensive care units and operating theatres: for use in the event of fire, flood, power cut, oxygen supply failure, noxious gas, structural collapse or other critical incidents: Guidelines from the Association of Anaesthetists and the Intensive Care Society. Anaesthesia 2021; 76:1377-1391. [PMID: 33984872 DOI: 10.1111/anae.15511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 12/21/2022]
Abstract
The need to evacuate an ICU or operating theatre complex during a fire or other emergency is a rare event but one potentially fraught with difficulty: Not only is there a risk that patients may come to harm but also that staff may be injured and unable to work. Designing newly-built or refurbished ICUs and operating theatre suites is an opportunity to incorporate mandatory fire safety features and improve the management and outcomes of such emergencies: These include well-marked manual fire call points and oxygen shut off valves (area valve service units); the ability to isolate individual zones; multiple clear exit routes; small bays or side rooms; preference for ground floor ICU location and interconnecting routes with operating theatres; separate clinical and non-clinical areas. ICUs and operating theatre suites should have a bespoke emergency evacuation plan and route map that is readily available. Staff should receive practical fire and evacuation training in their clinical area of work on induction and annually as part of mandatory training, including 'walk-through practice' or simulation training and location of manual fire call points and fire extinguishers, evacuation routes and location and operation of area valve service units. The staff member in charge of each shift should be able to select and operate fire extinguishers and lead an evacuation. Following an emergency evacuation, a network-wide response should be activated, including retrieval and transport of patients to other ICUs if needed. A full investigation should take place and ongoing support and follow-up of staff provided.
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Affiliation(s)
- F E Kelly
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - C R Bailey
- Department of Anaesthesia, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - P Aldridge
- Fire, Security and Corporate Affairs, Leeds Teaching Hospitals NHS Trust and General Secretary, National Association of Healthcare Fire Officers, UK
| | - P A Brennan
- Portsmouth Hospitals University Trust, Portsmouth, UK
| | - R P Hardy
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - P Henrys
- BOC Ltd, British Compressed Gas Association Medical Gas Committee
| | - A Hussain
- AH Fire Ltd, Member of the National Association of Healthcare Fire Officers, UK
| | - M Jenkins
- Intensive Care Unit, Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - A Lang
- Human Factors Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - N McGuire
- Devices, Medicines and Healthcare products Regulatory Agency
| | - A McNarry
- Department of Anaesthesia, Western General Hospital, Edinburgh, UK
| | - M Osborn
- Department of Oncology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - L Pittilla
- North of England Paediatric Critical Care Network and Paediatric Critical Care Society
| | - M Ralph
- NHS Improvement (Department of Health) and Chair, Medical Gas Association
| | - S Sarkar
- Department of Anaesthesia and Intensive Care Medicine, Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK
| | - D Taft
- Health and Safety Executive
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Kelly FE, Ralph M, Henrys P. Oxygen enrichment in clinical areas using high-flow nasal oxygen and non-invasive respiratory support. Anaesthesia 2021; 76:1137-1138. [PMID: 33840124 DOI: 10.1111/anae.15479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Affiliation(s)
- F E Kelly
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - M Ralph
- NHS Improvement and Medical Gas Association, UK
| | - P Henrys
- BOC Ltd and British Compressed Gas Association Medical Gas Committee, UK
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Bousquet J, Akdis CA, Jutel M, Bachert C, Klimek L, Agache I, Ansotegui IJ, Bedbrook A, Bosnic‐Anticevich S, Canonica GW, Chivato T, Cruz AA, Czarlewski W, Del Giacco S, Du H, Fonseca JA, Gao Y, Haahtela T, Hoffmann‐Sommergruber K, Ivancevich J, Khaltaev N, Knol EF, Kuna P, Larenas‐Linnemann D, Mullol J, Naclerio R, Ohta K, Okamoto Y, O’Mahony L, Onorato GL, Papadopoulos NG, Pfaar O, Samolinski B, Schwarze J, Toppila‐Salmi S, Ventura MT, Valiulis A, Yorgancioglu A, Zuberbier T, Pawankar R, Mubeccel A, Mona A, Emilio AC, Hasan A, Cristina AM, Zeinab A, Mostafa BE, Sergio B, Cristina B, Eric B, Bianca B, Elisabeth B, Larl‐Christian B, David B, Leif B, Attilio B, Sergio B, isabelle B, Jacques B, Louis‐Philippe B, Fulvio B, Christopher B, Roland B, Carmen B, Andrew B, William B, Fernan C, Davide C, Silvia C, Paulo C, Walter C, Vicky C, Kai‐Hakon C, Warner C, Thomas C, Lorenzo C, Alfonso CM, Niels C, Ekaterine C, George C, Derek C, Cemal C, Giorgio C, Ieva C, Sousa Jaime CD, del Carmen CD, André C, Linda C, Alvaro C, Adnan C, Ulf D, Frédéric DB, Diana D, Pascal D, Philippe D, Alain D, Ratko D, Maria DCT, Dejan D, Ruta D, Stephen D, Patrik E, Yehia E, Regina E, Bieren Julia E, Alessandro F, Wytske F, Mina G, Luis GRJ, Bilun G, Sonya G, José G, Maximiliano G, Maia G, Ineta G, Marta G, Antonieta GM, Adnan H, Elham H, Jonathan H, Martin H, Yunuen HV, Guido I, Carla I, Zhanat I, Edgardo J, Ewa J, Erika J, Sebastian J, Guy J, Ki‐Suck J, Jocelyne J, Igor K, Omer K, Fuat K, Przemyslaw K, Jussi K, Jorg K, Gerard K, Marek K, Mikael K, Violeta K, Amir L, Susanne L, Lan L, Marcus L, Michael L, Jing L, Philip L, Brian L, Karin LC, Bassam M, Mika M, Hans‐Jorgen M, Gailen M, Pedro M, Mohammad M, Juan‐José M, Cem M, Erik M, Eli M, Hans M, Jean‐Pierre M, Florin M, Neven M, Branislava M, Yousser M, Mathieu M, Mario M, Ralph M, Lars M, Antonella M, Tihomir M, Alla N, Leyla N, Kristof N, Laurent N, Robyn O, Kimihiro O, Brian O, Luigi PP, Isabella P, Petr P, Nilos P, Sim PH, Ruby P, Ana P, Bernard P, Constantinos P, Davor P, Wolfgang P, Todor P, Fabienne P, Paul P, Lars P, Emmanuel P, Claus R, Stella RM, Janet R, José Angelo R, Graham R, Nicolas R, Antonino R, Jose R, Nelson R, Lanny R, Philip R, Dermot R, Mario S, Joaquin S, Glenis S, Elie S, Nikolaos S, Estelle S, Juan‐Carlos S, Dirceu S, Talant S, Manuel S, Cristiana S, Rafael S, Timo S, Charlotte SU, Carel T, Peter‐Valentin T, Massimo T, Ioana T, Marilyn UP, Erkka V, Eric VG, Marianne VH, Olivier V, Petra V, Martin W, Dana W, Yun WD, Susan W, Magnus W, Dennis W, Barbara Y, Arzu Y, Osman Y, Mario Z, Mihaela Z. Intranasal corticosteroids in allergic rhinitis in COVID-19 infected patients: An ARIA-EAACI statement. Allergy 2020; 75:2440-2444. [PMID: 32233040 DOI: 10.1111/all.14302] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 01/02/2023]
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Ng YS, Lax N, Schaefer A, Radunovic A, Ralph M, Alhakim A, Taylor R, Turnbull D, McFarland R, Gorman G. SUDDEN UNEXPECTED DEATH IN ADULTS WITH M. 3243A>G MUTATION. J Neurol Neurosurg Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309236.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hiew C, Lim I, Zakhem B, Cox N, Rametta S, Irons D, Walton A, Pillay P, Seow S, Ralph M, Cecchin S, Wardlaw H, Cowie K, Lim Y. Clinical Experience of Primary Angioplasty for ST Elevation Myocardial Infarction (STEMI) in a High Volume Centre Without On-Site Surgical Back Up. Heart Lung Circ 2007. [DOI: 10.1016/j.hlc.2007.06.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Langill G, Ralph M, Ware ML. Working to promote and maintain a safe and secure environment in a hospital setting. Healthc Manage Forum 2005; 13:63-5. [PMID: 15892322 DOI: 10.1016/s0840-4704(10)60781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article examines how one hospital developed an approach to creating a safer and more secure environment for staff and patients. A cross-functional task group promoted a review of existing practices and processes related to the issue of violence in the workplace. The task group made recommendations for improving prevention, response, and the reporting of violent incidents. Results to date indicate that this approach is working to meet the goal of a safer and more secure environment.
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Aguilar-Roblero R, Aréchiga H, Ashkenazi I, Burioka N, Cipolla-Neto J, Cornélissen G, Markus R, Marques N, Menezes AA, Monk TH, Ralph M, Valdez-Ramirez P, Menna-Barreto L. The brain decade in debate: IV. Chronobiology. Braz J Med Biol Res 2001; 34:831-41. [PMID: 11449300 DOI: 10.1590/s0100-879x2001000700001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present article is the adapted version of an electronic symposium organized by the Brazilian Society of Neuroscience and Behavior (SBNeC) which took place on June 14, 2000. The text is divided into three sections: I. The main issues, II. Chronodrugs, and III. Methods. The first section is dedicated to the perspectives of chronobiology for the next decade, with opinions about the trends of future research being emitted and discussed. The second section deals mostly with drugs acting or potentially acting on the organism's timing systems. In the third section there are considerations about relevant methodological issues concerning data analysis.
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Affiliation(s)
- R Aguilar-Roblero
- Departamento de Neurociencias, Instituto de Fisiología Celular, Universidad Nacional Autonoma do México, DF, México
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Abstract
Neurodegenerative diseases caused by lysosomal enzyme deficiencies are catastrophic illnesses with both peripheral organ and central nervous system abnormalities. The mucopolysaccharidosis type VII mouse with beta-glucuronidase deficiency was used to develop an alternate approach to gene therapy, in which a "universal" cell line engineered to secrete the missing enzyme is implanted directly into all recipients requiring the same enzyme replacement. The cells, though nonautologous, were rendered immunologically tolerable by protection in immunoisolating microcapsules. Since the blood-brain barrier impedes the passage of large molecules such as beta-glucuronidase, encapsulated cells producing beta-glucuronidase were introduced directly into the lateral ventricles of the brain. Based on this strategy, beta-glucuronidase was delivered throughout most of the central nervous system, reversing the histological pathology and reducing the previously elevated levels of lysosomal enzymes beta-hexosaminidase and alpha-galactosidase. The effectiveness of this approach was further demonstrated with improvements in the mutant circadian rhythm behavioral abnormalities. Compared to wild-type and heterozygous mice, the mutant mice had an unstable periodicity, fragmented activity, and a sixfold reduction in wheel running activity. After treatment, the mutant behavioral abnormalities were significantly improved with a more stable periodicity and a less fragmented pattern of activity. While the overall total activity level did not increase in the treated mutants, it did not show the deterioration observed in the sham-treated as well as in the untreated mutant mice. Hence, this alternative cell-based gene therapy demonstrates biochemical, histological, and behavioral efficacy and provides a potentially cost-effective and nonviral treatment applicable to all lysosomal storage diseases with neurological deficits.
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Affiliation(s)
- C J Ross
- Department of Biology, McMaster University, Hamilton, Ontario, L8N 3Z5, Canada
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Ross CJ, Ralph M, Chang PL. Delivery of recombinant gene products to the central nervous system with nonautologous cells in alginate microcapsules. Hum Gene Ther 1999; 10:49-59. [PMID: 10022530 DOI: 10.1089/10430349950019183] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Somatic gene therapy using nonautologous recombinant cells immunologically protected with alginate microcapsules has been successfully used to treat rodent genetic diseases. We now report the delivery of recombinant gene products to the brain in rodents by implanting microencapsulated cells for the purpose of eventually treating neurodegenerative diseases with this technology. Alginate-poly-L-lysine-alginate microcapsules enclosing mouse C2C12 myoblasts expressing the marker gene human growth hormone (hGH) at 95+/-20 ng/million cells/hr were implanted into the right lateral ventricles of mice under stereotaxic guidance. Control mice were implanted similarly with nontransfected but encapsulated cells. Delivery of hGH to the different regions of the brain at various times postimplantation was examined. At 7, 28, 56, and 112 days postimplantation, hGH was detected at high levels around the implantation site and also at lower levels in the surrounding regions, while control mice showed no signal. Immunohistochemical staining of the implanted brains showed that on days 7, 56, and 112 postimplantation, hGH was localized in the tissues around the implantation site. Mice implanted with encapsulated but nontransfected cells showed no signal. Hence, the feasibility of using encapsulated nonautologous cells to deliver recombinant gene products to the brain for extended periods may allow the application of this technology to the treatment of neurodegenerative genetic disorders.
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Affiliation(s)
- C J Ross
- Department of Biology, McMaster University, Hamilton, Ontario, Canada
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Kronforst-Collins MA, Moriearty PL, Ralph M, Becker RE, Schmidt B, Thompson LT, Disterhoft JF. Metrifonate treatment enhances acquisition of eyeblink conditioning in aging rabbits. Pharmacol Biochem Behav 1997; 56:103-10. [PMID: 8981616 DOI: 10.1016/s0091-3057(96)00164-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The cholinergic system is known to show deterioration during aging and Alzheimer's disease. In response, a therapeutic approach to Alzheimer's disease has been to attempt to compensate for the decrease in central cholinergic function by potentiating the activity of the remaining intact cholinergic cells with cholinesterase inhibitors. In this study treatment with the long-lasting cholinesterase inhibitor metrifonate enhanced acquisition of eyeblink conditioning in aging rabbits without producing interfering side effects. The effects of metrifonate on central and peripheral cholinesterase activity were evaluated, as was the involvement of plasma atropine esterase activity on the central and peripheral response to metrifonate. Results demonstrate that metrifonate can produce predictable, dose-dependent ChE inhibition. Associative learning in the aging rabbit was improved by metrifonate-induced steady state ChE inhibition within a range of 30-80%. Metrifonate was behaviorally effective in the absence of the severe side effects which typically plague cholinesterase inhibitors, suggesting that metrifonate is a possible treatment for the cognitive deficits resulting from normal aging and Alzheimer's disease.
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Affiliation(s)
- M A Kronforst-Collins
- Department of Cell & Molecular Biology, Northwestern University Medical School, Chicago, IL 60611, USA
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